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Exceptionality Education International
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Traumatic Brain Injury: Persistent Misconceptions
and Knowledge Gaps Among Educators
Deborah E'el, PhD, NCSP
Eugene School District 4J5'&6̕:;<#=>&<&8$
Ann E. Glang PhD
Center on Brain Injury Research & Training5'=?#=>?9$"/&?"><&8$
Bonnie Todis
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Susan C. Davies
University of Dayton5',8=A1&,-9$8=B0"><&8$
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Exceptionality Education International
2016, Vol. 26, No. 1, pp. 1–18
ISSN 1918-5227 1
Traumatic Brain Injury: Persistent Misconceptions and
Knowledge Gaps Among Educators
Deborah Ettel
Eugene School District 4J
Ann E. Glang, Bonnie Todis
University of Oregon
Susan C. Davies
University of Dayton
Abstract
Each year approximately 700,000 U.S. children aged 0–19 years sustain a
traumatic brain injury (TBI) placing them at risk for academic, cognitive,
and behavioural challenges. Although TBI has been a special education
disability category for 25 years, prevalence studies show that of the
145,000 students each year who sustain long-term injury from TBI, less
than 18% are identified for special education services. With few students
with TBI identified for special education, TBI is mistakenly viewed as a
low-incidence disability, and is covered minimally in educator preparation.
We surveyed educators and found that they lacked knowledge, applied
skills, and self-efficacy in working with students with TBI. While those with
special education credentials and/or additional training scored
significantly higher than general educators, all demonstrated inadequate
skills in working with students with TBI. This finding suggests that
teachers, especially those in general education, have misconceptions and
knowledge gaps about TBI and its effects on students. Misconceptions have
led to the misidentification and under-identification of students with TBI,
leaving this group of students with disabilities potentially underserved. To
meet the academic and behavioural needs of students with TBI, all
educators need effective training in working with students with TBI.
Ettel, Glang, Todis, & Davies
2 Exceptionality Education International, 2016, Vol. 26, No. 1
Each year approximately 700,000 U.S. children aged 0–19 years sustain a traumatic brain
injury (TBI) requiring hospitalization or emergency treatment (Faul, Xu, Wald, &
Coronado, 2010). Children with TBI are at risk for a range of challenges that impair
academic performance and their transition to post-secondary education and employment
(Anderson, Catroppa, Morse, Haritou, & Rosenfeld, 2009; Beauchamp et al., 2011;
Catroppa & Anderson, 2007; Chapman et al., 2010; Ganesalingam et al., 2011; Gerrard-
Morris et al., 2010; Kurowski et al., 2011; Yeates et al., 2005). Children with moderate to
severe injuries are likely to have cognitive, behavioural, and social difficulties that affect
their long-term quality of life (Rivara, Vavilala, et al., 2012). Even mild injuries to the
developing brain (i.e., concussion) can result in persistent neural alterations (Eisenberg,
Andrea, Meehan, & Mannix, 2013; Rivara, Koepsell, et al., 2012; Walz, Cecil, Wade, &
Michaud, 2008) that significantly affect social and educational functioning (Sesma,
Slomine, Ding, McCarthy, & the Children’s Health After Trauma Study Group, 2008).
Effects of TBI on School Performance
Although students with TBI share some characteristics with students with other
disabilities, the unpredictable mix of cognitive, behavioural, and social impairments
associated with TBI are unfamiliar to most teachers (Glang et al., 2015). Inconsistent
learning profiles, knowledge gaps, and lack of self-awareness pose particular challenges
in the classroom setting (Farmer, Clippard, & Luehr-Wiemann, 1996; Farmer & Johnson-
Gerard, 1997; Glang, Sohlberg, & Todis, 1999; Telzrow, 1987; Ylvisaker & Feeney,
1998). Impairment of executive functioning, attention, concentration, and processing
speed following TBI also contribute to academic difficulties (Halstead et al., 2013;
Iverson, Brooks, Collins, & Lovell, 2006; Moser, Schatz, & Jordan, 2005); and up to a
third of students with TBI also develop behavioural or psychological symptoms (Barlow
et al., 2010; Rimel, Giordani, Barth, Boll, & Jane, 1981; Willer & Leddy, 2006; Yeates,
2010). Because many teachers are unaware of the effects TBI can have on behaviour,
behaviour problems are often misdiagnosed as premorbid rather than being appropriately
linked to the TBI (Clark, Russman, & Orme, 1999).
TBI at any point during childhood can disrupt normative development, contributing
to subsequent deficits in performing age-appropriate functions. Children who sustain
injuries in infancy and early childhood often have significant skill deficits and poor long-
term outcomes that might not be recognized as consequences of their injury. Although
students injured in adolescence often recover many of the academic skills and knowledge
acquired before the injury, they are likely to have difficulty learning new material and
developing higher order reasoning, organizational, and social skills (Anderson &
Catroppa, 2005; Anderson, Catroppa, Morse, Haritou, & Rosenfeld, 2005).
TBI Identification Rates
Of the 700,000 yearly childhood (ages 0–19) TBIs that require hospitalization,
prevalence studies (Zaloshnja, Miller, Langlois, & Selassie, 2008) report that
approximately 145,000 cases result in a long-term or lifelong TBI-related disability. The
number of students enrolled in the TBI category of special education is 26,000 (U.S.
Department of Education National Center for Education Statistics, 2015), indicating that
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 3
fewer than 18% of students who likely need services are receiving them. Special
education identification rarely occurs after the first year post-injury, so children with
early injuries or emerging problems are unlikely to be identified (Taylor et al., 2003).
When academic and behaviour problems become evident years later, they are likely to be
linked to specific learning disability (SLD) or behaviour disorders, rather than TBI. In a
recent survey, most state special education directors reported that students with TBI are
not appropriately identified in their states, and fewer reported a TBI specialist within the
state education agency than in 1999 (Glang, Todis, Ettel, & Yeates, 2013).
Misidentification of TBI as another disability can contribute to incomplete or
inappropriate assessment and resultant support services. Unlike some other disabilities,
the recovery process for students with TBI is often dynamic, requiring frequent
monitoring and program adjustment; some sequelae may not fully appear until long after
the injury is forgotten. The student with TBI may have underlying vision, sensory, gait,
mood, or fatigue issues that may go unaddressed because of misidentification or lack of
awareness. Further, the social-emotional needs of a student (and family) recovering from
brain injury are typically very different from those of a student with a lifelong learning
disability. Unlike most disabilities, with TBI there is a “before” and “after.” Consider the
differences between a once high-achieving, socially adept student whose post-TBI status
is suddenly significantly impaired and the student with a longstanding learning or
behaviour disorder. While under-identification of TBI clearly has costs, so, too, does
misidentification (Dyches & Prater, 2010).
Failure to provide appropriate educational services to students with TBI could be due
in part to lack of teacher knowledge and skills (Todis & Glang, 2008; Todis, Glang,
Bullis, Ettel, & Hood, 2011). Surveys of speech-language pathologists (Evans, Hux,
Chleboun, Goeken, & Deuel-Schram, 2009), school psychologists (Hooper, 2006), and
teachers (Davies, Fox, Glang, Ettel, & Thomas, 2013) reveal limited training in
assessment and intervention with TBI, suggesting inadequate preparation across
professions. A recent survey of teachers in the United Kingdom also demonstrated this
lack of preparation, and suggested that teachers hold misconceptions about TBI, which
may adversely affect the child’s school experience (Linden, Braiden, & Miller, 2013). A
recent survey of state directors of special education showed that state leaders believe their
annual TBI student counts are inaccurate; more than a quarter of those indicate that the
inaccuracy was significant (Glang et al., 2015). One of the main reasons given for that
inaccuracy was lack of teacher awareness about TBI as a disability (e.g., teachers not
understanding the long-term consequences of TBI and parents’ and professionals’
unfamiliarity with the characteristics of students with brain injury, the definitions used by
schools, and the consequences of injury on school performance). Another reason state
directors gave for the inaccuracy was misidentification of students with TBI. State
directors reported that in only 40% of cases were students with TBI identified under the
category of TBI; students with TBI were more often identified under the categories of
SLD, other health impairment, emotional disturbance, and others, or not identified at all
(Glang et al., 2015).
Furthermore, a recent analysis of ten university textbooks revealed that TBI is
minimally discussed in current special education texts (Ettel, McCart, & Glang, 2014). Of
the approximately 500 pages in each text, only an average of 9.8 pages contained
Ettel, Glang, Todis, & Davies
4 Exceptionality Education International, 2016, Vol. 26, No. 1
information about TBI. Only one of the top ten most widely used special education texts
(Turnbull, Turnbull, Wehmeyer, & Shogren, 2013) devoted a chapter specifically to TBI,
although in the United States TBI has been an Individuals with Disabilities Education Act
(IDEA) disability category since 1990. All ten books had a specific chapter on autism
spectrum disorder, and several included a chapter on attention deficit-hyperactivity
disorder, which is not a disability category. Thus, the limited coverage of TBI in teacher
preparation texts supports state special education directors’ perception that educators lack
awareness of TBI—the core texts on disabilities only minimally address TBI compared to
other disability categories.
The purpose of the present study was to assess educator knowledge, skills, and self-
efficacy related to TBI in a sample of teachers currently working in public schools.
The study’s research questions were:
1. What are the current levels of teacher knowledge and skill application in working
with students with TBI?
2. How do teachers rate their ability to work effectively with students with TBI
(self-efficacy)?
3. Which teacher characteristics predict knowledge, skills, and self-efficacy in
working with students with TBI?
Methods
Participants
We recruited participants through print and online advertising on LDOnline, a
website that targets general and special education teachers working with students with
learning disabilities. Potential participants accessed an online screening tool by clicking a
link on the website. A total of 352 teachers participated in the survey. Most of the teachers
were from the United States (82%), were special education teachers (62%), and had
obtained a master’s degree or greater (75%). Respondents included preschool through high
school teachers, and the sample was evenly distributed across the grades. Twenty-five
percent of the sample indicated they had taught for 26 or more years. About one third had
taught for 1–10 years, and another third had taught for 11–25 years. In addition, about one
third of the respondents (33%) indicated that they had worked with 1–5 students with TBI,
and more than half (55%) indicated that they had previously worked with 6–10 students
with TBI. Only about one quarter of the teachers said that they had prior training in
working with students with TBI, but almost all said that they had worked with at least one
student with TBI (85% worked with 1–10 students with TBI).
Instruments
TBI knowledge. The TBI Knowledge Survey was adapted from a validated
instrument (Hux, Bush, Evans, & Simanek, 2013; Hux, Walker, & Sanger, 1996), with
additional items derived from TBI training materials (Dise-Lewis, Lewis, & Reichardt,
2009; Glang, Tyler, Pearson, Todis, & Morvant, 2004). The final 30-item adapted version
for the current study (see Appendix) included a four-point response option (true,
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 5
probably true, probably false, and false). For scoring, responses were combined to form
two categories, true–probably true and false–probably false. The number of correct items
was summed and a percentage correct computed.
TBI skill application and self-efficacy. TBI skill application—knowledge
application—was assessed with four scenarios depicting classroom situations involving
students with TBI. Each scenario was assessed with a six-point scale (would never
respond this way, fairly unlikely, not very likely, somewhat likely, fairly likely, and very
likely to respond this way). The responses fairly likely to respond this way and very likely
to respond this way were combined and scored as correct in response to the correctly
handled scenarios. Likewise, the responses fairly unlikely to respond this way and would
never respond this way were combined and scored as correct in response to the
incorrectly handled scenarios. A total score of number of correct responses was
computed. Because self-efficacy is theoretically linked to behaviour change (Ajzen,
1991; Ajzen, Joyce, Sheikh, & Gilbert Cote, 2011), survey items also assessed this
construct with the same four scenarios (e.g., “How confident are you that you could
successfully handle a situation like this?”) using a six-point scale (1 = not at all
confident, 6 = completely confident; alpha = .82).
A copy of the teacher survey appears in the Appendix.
Procedures
The evaluation was conducted over Survey Console, a secure server on the Internet.
When potential participants accessed the link provided in the study advertisements, they were
taken directly to the survey and given a unique identifier access number. For participating in
the study, participants were offered a chance to win one of five $200 cash awards.
Data Analysis
We used independent t-tests and one-way ANOVA models with Scheffé follow-up
tests to examine whether TBI knowledge, skill application, and self-efficacy differed by
the following teacher characteristics: (a) current area of teaching, (b) special education
license held, (c) history of TBI training, (d) years of teaching experience, and (e) number
of students with TBI worked with in a school setting. We provide Cohen’s d-statistic
(Cohen, 1988) as a measure of effect size following the convention of d=.2, small; d= .5,
medium; and d= .8, large effects.
Results
The average TBI knowledge score across all teachers was 55.9 % (SD = 9.8, range
26.6–80.0). Three statistically significant differences in TBI knowledge scores by teacher
characteristics appeared. Special education teachers had significantly higher knowledge
scores than general education teachers (56.8 vs. 54.3), a moderately small effect (d =
.25); teachers with a history of TBI training had significantly higher knowledge scores
than teachers without training (58.4 vs. 55.1), a moderately small effect (d = .34); and
years of teaching experience was significantly related to knowledge scores, a moderately
Ettel, Glang, Todis, & Davies
6 Exceptionality Education International, 2016, Vol. 26, No. 1
small effect (d = .37). Follow-up Scheffé contrasts found no categories of years of
teaching that statistically differed at p < .05.
The average TBI skill application score across all teachers was 72 % (8.6/12 [SD =
2.1, range 0–12]). We found two statistically significant differences in TBI skill
application scores by teacher characteristics (Table 1). Special education teachers had
significantly higher TBI skill application scores than general education teachers (8.9 vs.
8.3), a moderately small effect (d = .31), and teachers who held a special education
license had significantly higher TBI skill application scores than those who did not have a
license (8.8 vs. 8.3), a small effect (d = .24).
Table 1
TBI Applied Skills Scores by Teacher Characteristics
The average TBI self-efficacy score across all teachers was 4.8 on a scale of 0–6 (SD
= 0.7, range 1.5–6.0). We found three statistically significant differences in self-efficacy
score by teacher characteristic (Table 2). Special education teachers had significantly
higher self-efficacy scores than general education teachers (4.9 vs. 4.6), a moderately small
effect (d = .41); teachers who held a special education license had significantly higher self-
efficacy scores than those who did not have a license (4.8 vs. 4.6), a moderately small
effect (d = .37); and the number of TBI students taught was significantly related to self-
efficacy scores, a moderately small effect (d = .36). Follow-up Scheffé contrasts found that
teachers who had never taught a student with TBI had significantly lower scores than
teachers who had taught more than 10 students with TBI (4.6 vs. 5.1).
Mean
SD
Test Statistic
p-value
Effect size
Current area of teaching
t(349) = 2.80
.006
.31
General education
8.25
2.12
Special education
8.88
1.99
History of TBI training
t(350) = 0.57
.566
.07
No
8.61
2.13
Yes
8.76
1.91
Years of teaching experience
F(5,346) = 0.86
.507
.22
0–5 years
8.41
1.91
6–10 years
8.62
1.99
11–15 years
9.11
2.04
16–20 years
8.48
1.89
21–25 years
8.68
2.46
26 or more years
8.51
2.06
No. of TBI students
F(3,347) = 0.50
.680
.13
0
8.52
2.26
1–5
8.73
1.96
6–10
8.36
2.26
More than 10
8.93
1.79
TBI = traumatic brain injury, SD = standard deviation, Effect size = Cohen’s d-statistic
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 7
Table 2
TBI Self-Efficacy Scores by Teacher Characteristics
Mean
SD
Test Statistic
p-value
Effect size
Current area of teaching
t(348) = 3.73
<.001
.41
General education
4.59
0.69
Special education
4.85
0.63
SPED license held
t(349) = 3.21
.001
.37
No
4.59
0.69
Yes
4.83
0.64
History of TBI training
t(349) = 1.46
.082
.18
No
4.72
0.66
Yes
4.84
0.67
Years of teaching experience
F(5,345) = 0.33
.895
.14
0–5 years
4.82
0.68
6–10 years
4.69
0.59
11–15 years
4.80
0.65
16–20 years
4.70
0.68
21–25 years
4.73
0.64
26 or more years
4.77
0.73
No. of TBI students
F(3,346) = 3.78
.011
.36
0
4.61
0.73
1–5
4.80
0.62
6–10
4.78
0.57
More than 10
5.11
0.76
SPED = special education, TBI = traumatic brain injury, SD = standard deviation, Effect size = Cohen’s d-
statistic
Discussion
The results of this survey suggest that during the 25 years since TBI became a
disability category under IDEA (“Individuals with Disabilities Education Act,” 1990),
teacher preparedness to work with students with TBI has not changed significantly.
Although special education teachers in our sample scored significantly higher than
general education teachers on knowledge of TBI, the knowledge scores for both groups
were below 60 %. If a minimum criterion for competence is 70 % correct—a C grade—
teachers (both general education and special education) earned an F. Hooper (2006)
reported similar rates of knowledge about TBI among school psychologists in two states
and in a sample of special education teachers in several states. In Hux’s (1996) study,
20% of special education teachers were unaware that TBI was even an eligibility
category for services (Glang et al., 2008).
In applied skills, teachers fared better, with an average of 72% on application of
appropriate instruction and intervention. However, it could be that on this skills measure,
despite a lack of specific TBI training, teachers applied their skills in working with all
students with disabilities or learning challenges to the scenarios.
Ettel, Glang, Todis, & Davies
8 Exceptionality Education International, 2016, Vol. 26, No. 1
We also found that greater knowledge of TBI is associated with years of teaching
experience and that working with 10 or more students with TBI across a teaching career
increased the ratings of self-efficacy. But the only significant difference was between
those who had never taught a student with TBI and those who had taught 10 or more, and
neither case is typical. Although it is logical that knowledge and self-efficacy would
improve with hands-on experience over the years, trial-and-error is not the most efficient
path for teachers to gain expertise with students with TBI. They—and the students they
serve—deserve competent support.
Teachers with more training demonstrated greater knowledge and applied skills and
reported greater self-efficacy than teachers with less training. This finding echoes the
recent assertion by state directors of special education that teachers’ lack of awareness of
TBI is a main cause of inaccurate identification of students with TBI, a finding further
reinforced by the limited coverage of TBI as a disability in teacher preparation textbooks.
Training in special education was associated with increased levels of knowledge,
TBI skills, and self-efficacy in working with students with TBI. However, since most
students with TBI are not identified for special education (U.S. Department of Education
National Center for Education Statistics, 2015; Zaloshnja et al., 2008), they are in many
cases served by teachers who are unprepared to work effectively with them. This finding
suggests that increased rates of special education identification among students with TBI
would provide them with the best opportunity to work with teachers who are at least
somewhat prepared to meet their specific needs
Increasing TBI training for all teachers might also address the issue of
misidentification of students with TBI under alternate eligibility categories.
Misidentification contributes to under-identification, leading to a misperception that TBI
is a low-incidence disability that few teachers will encounter in their classrooms. This
misperception in turn leads districts and states, as well as teacher preparation programs,
to underestimate the need for training and research in TBI. Accurate identification would
increase the visibility of students with TBI and increase the likelihood that those students
would receive appropriate support services. Accurate identification will not be possible,
however, without increased teacher knowledge and skills in TBI. Increased awareness of
TBI is the key to correcting the downward spiral that characterizes current educational
practices for students with TBI.
Limitations
The survey participants represent a convenience sample, a nonprobability sample
with inherent biases. While cost effective, this nonrandom sampling method leaves
doubts about the extent to which results may be generalized to the larger population.
Further, the use of a closed (as opposed to an open-ended) response system of
measurement in our scenario questions may have inaccurately captured the extent of
teacher knowledge.
In this study, teacher ratings of self-efficacy served as a proxy for their skill in meeting
the needs of students with TBI. Teachers with higher self-efficacy have been found to show
more support and provide a more positive classroom environment than those with lower
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 9
self-efficacy, and their students showed stronger literacy skills (Guo, Connor, Yang,
Roehrig, & Morrison, 2012). Observational studies comparing delivery of services by
trained and untrained teachers would provide a more accurate assessment of teacher skill in
instruction and behaviour management. However, because the ultimate goal of assessing
teacher preparedness is to gauge teachers’ ability to effect positive student change, a
randomized study comparing student outcomes under different teaching conditions would
provide the most accurate assessment of the effects of different levels of teacher knowledge
and awareness on teacher behaviour and its effects on students with TBI. But the feasibility
of such a study is limited by ethical, procedural, and financial considerations.
Conclusion
The goal of special education is to provide services to students that make it possible
for them to achieve their full potential. Achieving that goal requires teachers who have
the awareness, knowledge, and skills to work effectively with each student, regardless of
disability condition. Currently, many students with TBI do not have access to special
education services, which suggests not only that assessment and identification practices
should be improved, but also that both general and special education teachers need to be
prepared to work with this population.
This survey suggests that teachers, especially those in general education, have some
basic misconceptions and knowledge gaps about TBI and the effects of brain injury on
students in their classrooms, the consequences of which are not minor. Misconceptions
have led to the misidentification and under-identification of students with TBI for special
education, leaving this group of students with disabilities potentially mis-served and
underserved. To meet the academic and behavioural needs of students with TBI, all
teachers need effective training, pre-service and in-service, in methods that have been
validated with students with TBI and in adapting strategies validated with students with
other disabilities to students with TBI (Dettmer, Ettel, Glang, & McAvoy, 2014; Glang,
Todis, Sublette, Eagan-Brown, & Vaccaro, 2010; Ylvisaker et al., 2005; Ylvisaker et al.,
2001). That was the expectation and promise of IDEA in 1990 when TBI became a
disability category.
References
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Authors’ Note
Correspondence concerning this article should be addressed to Deborah Ettel, 2750 Capital Drive,
Eugene, OR, 97403, USA. Email: drdeb2009@gmail.com
!
Appendix
!
TBI$Knowledge$Survey$!
$
$
Your$Current$Area$of$Teaching:$
!!!"#$#%&'!()*+&,-.$!!!!/0#+-&'!()*+&,-.$!
!
$
Current$Grade(s)$Taught$(select$all$that$apply):$
1%#2+3..'!!!4!!!5!!!6!!!7!!!8!!!9!!!:!!!;!!!<!!!=!!!5>!!!55!!!56!
!
$
Highest$Degree$Earned:$
!! !?&+3#'.%@2!!A&2,#%@2!!B.+,.%&,#!
!
$
Date$Highest$Earned:$
!!?#C.%#!5=;>!!!!5=;>D<>!!!!5=<5D=>!!!5==5D6>>>!!!!6>>5D6>5>!
!
$
Areas$of$certification(s)/license(s)$held:$
!!!"#$#%&'!()*+&,-.$!!!/0#+-&'!()*+&,-.$!
!
$
Were$you$trained$or$are$you$being$trained$in$traumatic$brain$injury$(TBI)?$$$
!!!E(/!!!FG!
!
$
!$
Ettel, Glang, Todis, & Davies
14 Exceptionality Education International, 2016, Vol. 26, No. 1
If$YES,$describe$what$kind$of$training$you$have$received$[check$all$that$apply]:$$
!!Class/seminar!specifically!devoted!to!TBI?!!
!!Survey!class!on!disabilities?!
!!Workshop!(halfDday!or!more)?!
!!InDservice/professional!development!seminar?!
!
$
Other$Training$(if$applicable)$
! !_____________________________________________________________________!!
!
$
Please$list$any$TBI$resources$that$were$used$in$your$training$(e.g.,$websites,$books,$training$
manuals,$etc.):$
! !_____________________________________________________________________!!
$
!
Teaching!Experience!
!
$
Years$of$teaching$experience:$$
!!0D5! !6D10!!11D15!!16D20!!21D25!!26+!
!
$
Approximately$how$many$students$with$TBI$have$you$worked$with$in$a$school$setting?$$$$
!!none!(0)!!few!(1D5)!!several!(6D10)!!many!(>11)!
$
$
Personal!Experience!
!
$
Do$you$have$a$close$friend$or$family$member$who$has$ever$sustained$a:$
! ! !YES! !NO!
!Concussion/mild!brain!injury!!!!!
!ModerateD!severe!brain!injury!!!
!
$
Have$you$ever$sustained$a:$
! ! !YES! !NO!
!Concussion/mild!brain!injury!!!!!
!ModerateD!severe!brain!injury!!!
!
$
! !
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 15
Section!1!
Please$mark$True,$Probably$True,$Probably$False,$or$False$
$
!
!
True!
Probably!
True!
Probably!
False!
False!
1.!
TBI!is!equally!common!in!males!and!females.!
!
!
!
!
2.!
A!child/adolescent!in!a!coma!is!usually!not!aware!of!
what!is!happening!around!!!them.!!
!
!
!
!
3.!
After!a!brain!injury,!children/adolescents!can!forget!who!
they!are!and!not!recognize!others,!but!be!‘normal’!in!
every!other!way.!!
!
!
!
!
4.!
A!brain!injury!affects!girls’!and!boys’!brains!differently.!!
!
!
!
!
5.!
Even!after!several!weeks!in!a!coma,!when!
children/adolescents!wake!up,!most!recognize!and!
speak!to!others!right!away.!!
!
!
!
!
6.!
After!a!brain!injury,!it!is!usually!harder!to!learn!new!things!
than!it!is!to!remember!things!from!before!the!injury.!!
!
!
!
!
7.!
A!child/adolescents!’s!preDinjury!status!(i.e.,!intellectual!
and!emotional!functioning)!is!likely!to!impact!recovery!
from!brain!injury.!!
!
!
!
!
8.!
Children/adolescents!who!have!had!one!brain!injury!are!
more!likely!to!have!a!second!one.!!
!
!
!
!
9.!
Complete!recovery!from!severe!brain!injury!is!not!
possible!no!matter!how!badly!the!child/adolescent!
wants!to!recover.!!
!
!
!
!
10.!
Children/adolescents!are!likely!to!recover!more!
completely!from!a!brain!injury!than!adults!due!to!the!
greater!plasticity!of!the!young!brain.!!
!
!
!
!
11.!
A!child!who!acquires!a!brain!injury!between!12!and!16!
will!typically!present!an!even!pattern!of!academic!
strengths!and!weaknesses.!!
!
!
!
!
12.!
A!child’s!brain,!unlike!an!adult’s,!is!able!to!“bounce!
back”!after!a!brain!injury.!!
!
!
!
!
13.!
It!is!common!for!children/adolescents!with!brain!injuries!
to!be!easily!angered.!!
!
!
!
!
14.!
Fluctuation!among!cognitive!abilities!is!a!finding!typical!
of!children!and!adolescents!who!have!a!brain!injury,!and!
not!typical!of!the!general!population!of!children!and!
adolescents.!!
!
!
!
!
15.!
When!children/adolescents!are!knocked!unconscious,!
most!wake!up!quickly!with!no!lasting!effects.!!
!
!
!
!
! !
Ettel, Glang, Todis, & Davies
16 Exceptionality Education International, 2016, Vol. 26, No. 1
Section!1,!continued!
Please$mark$True,$Probably$True,$Probably$False,$or$False$
$
!
!
True!
Probably!
True!
Probably!
False!
False!
16.!
It!is!important!to!provide!many!details!when!delivering!
instructions!to!a!student!with!brain!injury.!!
!
!
!
!
17.!
Greater!variability!exists!in!the!population!of!students!
with!TBI!than!exists!in!populations!of!other!students!
with!disabilities.!!
!
!
!
!
18.!
The!only!sure!way!to!tell!if!someone!has!suffered!brain!
impairment!from!a!brain!injury!is!by!an!XDray!of!the!brain.!!
!
!
!
!
19.!
Knowing!the!location!of!brain!injury!resulting!from!TBI!
helps!in!the!development!of!programming!to!meet!a!
student’s!needs.!
!
!
!
!
20.!
Many!students!with!TBI!display!characteristics!similar!to!
those!of!students!with!a!learning!disability.!!
!
!
!
!
21.!
Knowledge!of!a!student’s!background!prior!to!TBI!is!
necessary!when!developing!an!educational!plan.!!
!
!
!
!
22.!
Medical!labels!that!specify!TBI!as!mild,!moderate,!or!
severe!are!useful!for!programming!communication!and!
academic!services.!!
!
!
!
!
23.!
The!primary!goal!of!brain!injury!rehabilitation!is!to!
increase!physical!abilities!such!as!walking.!!
!
!
!
!
24.!
Many!students!with!TBI!perform!better!in!structured!
testing!situations!than!they!do!in!classroom!settings.!!
!
!
!
!
25.!
The!challenges!of!students!with!TBI!are!typically!more!
difficult!to!assess!than!the!challenges!of!students!with!
other!disabilities.!!
!
!
!
!
26.!
Most!special!and!regular!educators!are!knowledgeable!
about!the!speech,!language,!and!cognitive!
communication!problems!associated!with!TBI.!!
!
!
!
!
27.!
Students!with!TBI!often!have!trouble!forming!and!
maintaining!friendships.!
!
!
!
!
28.!
Recovery!following!TBI!may!continue!for!several!years.!!
!
!
!
!
29.!
Students!with!TBI!often!display!behavior!problems.!!
!
!
!
!
30.!
Standardized!tests!are!more!beneficial!than!descriptive!
measures!(e.g.,!language!samples,!interviews,!checklists,!
observations)!in!assessing!cognitive!deficits!secondary!
to!TBI.!
!
!
!
!
! !
TBI: Persistent Misconceptions
Exceptionality Education International, 2016, Vol. 26, No. 1 17
Section!2!
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.4'.&.4"&04,#+&,-&8*"/.,$-&4'/&9:;<=<>?;>@A&/4$%-&.4"&+"/0(,B"+&B"4'C,$(&'-+&,.&,/&;:>&'-&,/$#'."+&
"C"-.5&>4"&04,#+&2'1&4'C"&B""-&,+"-.,),"+&'/&4'C,-3&4'+&'&.('*2'.,0&B(',-&,-D*(1&E>!=F&$(&1$*&/*/G"0.&
.4'.&4"H/4"&2'1&4'C"&4'+&'&>!=5&I#"'/"&('."&4$%&#,J"#1&1$*&'("&.$&("/G$-+&,-&"'04&G$//,B#"&("/G$-/"5&
<0$("&?K9L&("/G$-/"&B1&4$%&#,J"#1&1$*&%$*#+&B"&.$&"2G#$1&"'04&'0.,$-&,-&.4"&/,.*'.,$-&+"/0(,B"+5&
MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM&
1)$Susan$has$difficulty$paying$attention$in$her$3rd$grade$class,$especially$in$the$afternoon.$She$
is$often$caught$daydreaming$or$is$otherwise$distracted$but$not$disruptive.$She$sometimes$
complains$of$headaches.$You$could:$
'5&
N"G$/,.,$-&4"(&+"/J&.$&)($-.&$)&($$2&/$&1$*&0'-&J""G&'-&"1"&$-&4"(&'-+&2',-.',-&4"(&'.."-.,$-5&&
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$
+5&L$%&0$-),+"-.&'("&1$*&.4'.&1$*&0$*#+&/*00"//)*##1&4'-+#"&'&/,.*'.,$-&#,J"&.4,/R$
&;$.&'.&'##&&P"(1&@,..#"&&<$2"%4'.&P"(1&9$-),+"-.&9$2G#"."#1&9$-),+"-.&
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MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM&
2)$All$through$middle$school$and$now$in$9th$grade,$Dave$rarely$hands$in$assignments$on$time,$
seldom$gets$to$class$before$the$bell$rings$and$inevitably$forgets$to$bring$books$or$pencil$to$
class.$He$has$the$ability$to$do$average$work$but$has$problems$initiating$tasks.$You$could:$
'5&>'J"&Q'C"S/&-$."B$$J&'-+&*/"&'&/"(,"/&$)&-$."/&#'2,-'."+&,-&.4"&-$."B$$J&.$&$*.#,-"&.4"&
/."G/&("8*,("+&)$(&1$*(&0#'//5&
&&;"C"(&&6',(#1&O-#,J"#1&&<$2"%4'.&@,J"#1&&6',(#1&@,J"#1&&P"(1&@,J"#1&
&
B5&<'1T&UA$*S("&,-&V.4&3('+"&-$%5&W'J"&/*("&1$*&0$2"&G("G'("+&)$(&0#'//&$(&1$*&2'1&"-+&*G&,-&
/*22"(&/04$$#5X&$(&/,2,#'(&%'(-,-3&$)&.4"&0$-/"8*"-0"/&$)&0$-.,-*"+&+,/$(3'-,Y'.,$-5&
&&;"C"(&&6',(#1&O-#,J"#1&&<$2"%4'.&@,J"#1&&6',(#1&@,J"#1&&P"(1&@,J"#1&
&
05&9$-)"("-0"&%,.4&Q'C"&'-+&4,/&G'("-./&.$&/.('."3,Y"&4$%&Q'C"&0'-&3".&.$&0#'//&$-&.,2"&'-+&B"&
G("G'("+&.$&G'(.,0,G'."&-$%&.4'.&4"&,/&,-&4,34&/04$$#5&
&&;"C"(&&6',(#1&O-#,J"#1&&<$2"%4'.&@,J"#1&&6',(#1&@,J"#1&&P"(1&@,J"#1&
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$
+5&How$confident$are$you$that$you$could$successfully$handle$a$situation$like$this?$
&;$.&'.&'##&&P"(1&@,..#"&&<$2"%4'.&P"(1&9$-),+"-.&9$2G#"."#1&9$-),+"-.&
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Ettel, Glang, Todis, & Davies
18 Exceptionality Education International, 2016, Vol. 26, No. 1
Section!2,!continued!
!
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD!
3)$Mary$hits,$shoves,$or$pushes$peers$and/or$adults$in$her$8th$grade$classes$with$little$or$no$
provocation,$and$uses$aggressive$or$threatening$language.$You$could:$
a.!Teach!Mary!strategies!for!identifying!impending!anger!or!frustration!and!allow!her!to!take!inD
class!timeDouts.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
b.!Establish!and!explain!clear!rules!for!expected!behavior!and!natural!or!logical!consequences!if!
the!rules!are!not!followed!and!consistently!follow!up!on!established!consequences.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
c.!Identify!any!“triggers”!that!seem!to!precede!the!aggressive!behaviors!and!manage!the!
environment!to!reduce!those!triggers.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
$
d.!How$confident$are$you$that$you$could$successfully$handle$a$situation$like$this?!
!Not!at!all!!Very!Little!!Somewhat!Very!Confident!Completely!Confident!
!
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD!
4)$Phillip$is$in$11th$grade$and$constantly$speaks$out$of$turn,$shows$off,$or$engages$in$other$
apparent$attentionZseeking$behavior.$It$is$often$disruptive$to$classroom$activities.$You$could:$
a.!Instruct!other!students!to!ignore!the!attentionDseeking!behaviors.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
b.!Ensure!that!strategies!are!in!place!to!enhance!Phillip’s!selfDesteem!and!selfDconcept!(such!as!
providing!challenging!and!meaningful!tasks)!so!he!has!less!need!to!act!out.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
c.!Provide!opportunities!for!him!to!work!successfully!with!other!students.!
!!Never!!Fairly!Unlikely!!Somewhat!Likely!!Fairly!Likely!!Very!Likely!
!
$
d.!How$confident$are$you$that$you$could$successfully$handle$a$situation$like$this?!
!Not!at!all!!Very!Little!!Somewhat!Very!Confident!Completely!Confident!
!
$
!
!
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